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Infertility Tests of the Woman

Jessica Evert, MD, edited by Benjamin McDonald, MD Updated: Jun 28th 2016

blood sampleHormone Levels: Often, a sample of a woman's blood is taken to evaluate hormone levels. Specifically, the Day 3 hormone levels of Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH) and estrogen are measured. As the name suggests, this test requires that a blood sample be drawn on Day 3 of your cycle. FSH is a hormone released by an area of the brain called the pituitary gland. FSH then travels to the ovaries where it stimulates an egg to mature. If the ovary is running out of eggs or not maturing eggs properly, the brain will try to put out more and more FSH in hopes of forcing proper egg maturation. Therefore, the Day 3 FSH level will be abnormally high. The drawback to this test is that results can appear normal even if there are problems with the quantity or quality of a woman's eggs. However, an abnormal result can help doctors determine why a woman is having trouble conceiving. Estrogen is another hormone that is typically examined, and it is often used as an indicator in women who have normal FSH levels. A high estrogen level result in the Day 3 test can signify that a woman has too few eggs or poor quality eggs.

The level of thyroid hormones (Thyroid Stimulating Hormone (TSH) and Thyroid Hormone) may also be measured with a blood test. The thyroid gland is important for regulating many body processes including menstruation. Low levels of thyroid hormone can cause a lack of ovulation and can lead to early pregnancy loss. In contrast, high levels of thyroid hormone can lead to irregular ovulation, premature labor, fetal abnormalities, and other problems.

Prolactin is another hormone that can interfere with ovulation. Women with high levels of prolactin often have noticeable symptoms such as milk coming from the nipples. Treatments for high prolactin levels include medication and surgical intervention (to remove hormone releasing tumors).

Androgens, which are male hormones such as testosterone, are normally present in low levels in women. When these male hormones are high in women they can lead to irregular or absent ovulation and can be indicative of problems such as Polycystic Ovarian Disease, obesity, or other illnesses.

Clomiphene Challenge Test: If a Day 3 FSH level is abnormal, doctors will often perform a Clomid or Clomiphene Challenge Test (abbreviated CCT). This test requires you to take Clomid or Serophene 100mg by mouth once a day for days 5-9 of your cycle (day 1 is defined as the day when bleeding starts). Blood is then drawn on Day 10 and the levels of FSH are checked. Clomid is a medication that affects the hypothalamus (a small gland at the base of the brain) and encourages the release of a hormone called gonadotropin releasing hormone (GnRH), which in turn increases levels of FSH. FSH then acts on the ovaries. An abnormal test result is when FSH levels are elevated on Day 10. The CCT and Day 3 FSH tests help doctors understand a woman's "ovarian reserve," including the ability of the ovary to respond to hormones and mature eggs. An abnormal CCT also signifies that a woman may not respond to hormone treatments for infertility and may require donor eggs if in-vitro fertilization is the chosen treatment option.

Ultrasound: Ultrasound, also known as Sonogram, involves the use of sound waves to create a picture to help doctors evaluate the organs necessary for getting pregnant. This painless test typically involves rubbing cold jelly on the abdomen (to help the sound waves transmit) and rubbing an ultrasound probe across the jellied area so as to direct the sound waves into the body. An image of the interior organ structures emerges as those sound waves reflect off body tissues and are interpreted by a computer.

In some cases, external abdominal ultrasound cannot produce a detailed enough image to be of use, and doctors will perform transvaginal ultrasound instead. Transvaginal ultrasound involves the insertion of an ultrasound probe into the vagina. Using this test, doctors can look at the ovaries, uterus, and fallopian tubes. Most commonly, ultrasound is used to examine the inside of the uterus (for possible fibroids or other masses) and ovaries to look for the maturation of follicles (eggs).


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